Designing health care facilities and medical campuses: Automation, controls and technology
- Andrew Flanagan, PE, GPD, LEED AP, Associate, Senior Plumbing Engineer, Interface Engineering, Portland, Ore.
- Mikhail Fuks, PE, HFDP, Engineering Group Leader, P2S Inc., Long Beach, Calif.
- Gary Hamilton, PE, LEED AP, CxA, EDAC, SASHE, Senior Vice President, WSP, Arlington, Va.
- Alex Harwell, Client Manager/Project Manager, Dewberry, Raleigh, N.C.
- Ted Hood, Senior Project Manager, TLC Engineering for Architecture, Brentwood, Tenn.
- George P. Isherwood, PE, Vice President, Peter Basso Associates Inc., Troy, Mich.
- Jeremy Jones, PE, LEED AP, EDAC, Healthcare Market Leader, Affiliated Engineers Inc., Chapel Hill, N.C.
- Brian Kannady, PE, Principal, ME Engineers, Golden, Colo.
CSE: From your experience, what mechanical, electrical, plumbing (MEP), or fire protection systems within health care buildings and medical facilities require specialized automation or controls that previously might not have, or have there been specific requests for increased automation?
Harwell: Temperature, humidity, and pressure controls within critical spaces, such as operating rooms and sterile processing areas. The increasingly narrow control windows for temperature and humidity, and the expanding list of spaces requiring pressure controls, necessitate additional controls and robust sequences to maintain, report, and document compliant conditions.
Jones: The new reimbursement dynamics are creating an increased focus on patient safety and prevention of readmissions due to hospital-acquired infections. More than ever, hospitals want to visualize, trend, and pre-emptively control the temperature/humidity and room pressurization of critical spaces. Whereas 10 years ago, an operating room might be equipped with a pressurization monitor with a local alarm, today that same operating room will have pressure/temperature and humidity alarms tied to the building automation system (BAS) on a dedicated “operating room conditions” screen. This screen displays historical trends as well as at-a-glance visuals of current issues. The alarm conditions are being tightened so that facilities staff is made aware of potential problems well before they result in conditions out of a safe range.
CSE: What types of automation and control features are you seeing on these types of projects that you wouldn’t on other facilities?
Jones: We have seen a drastic increase in the desire for monitoring, metering, and trending. Hospitals are second only to restaurants in energy-use intensity (EUI), and operating margins for health care are historically very low. Improvement in energy efficiency is key. Building owners are realizing that you can’t improve what you can’t measure and identify. There is a big difference between suspecting that your facility’s EUI is higher than your competitors’ versus being able to pinpoint exactly where your energy dollars are being spent, how they trend over time, and where outliers might be. The latter is much simpler to improve.
CSE: Have you experienced the Internet of Things (IoT) come up in discussion or implemented on such projects? How has this integration impacted the project? If so, please give an example.
Ted Hood: IoT is definitely a topic of interest with most health systems. The challenge is the volume of potential solutions on the market and under development. Commercial devices, biomedical devices, wearable technologies, patient/family devices, apps, and various virtual-care solutions must be considered. Developing a long-term roadmap that creates a vision for how each facility may merge, integrate, and manage these technologies has proven helpful in determining how to address them at the project level for opening day. This process defines the flexible spaces and adaptable infrastructure needed. This has helped clients consider telehealth needs in clinics, future eCare monitoring spaces, and soft-space clinical command centers for future virtual care. A robust wireless infrastructure has also been a key element for future adaptability.
Harwell: Occasionally, but the use of internet-based communications for any hospital system has been a tough pill to swallow for most facility information technology (IT) leaders. Security of a wireless or external network has always been the roadblock.
CSE: For new medical facilities, have you experienced building owners requesting equipment and systems to be connected using IoT technology or some other type of asset-management or automation tool? If so, please describe the process/your experience.
Hood: Keeping track of and managing the enormous amount of medical equipment and IT devices can be challenging to hospital staff. Many facilities use real-time locating systems to help clinical and technical teams quickly locate devices and help with ongoing maintenance protocols. Assessing the level of tracking is needed for proper system design. For example, some facilities may only want to know a wireless PC workstation is located on the west wing of the 3rd floor. Other facilities will want to know an IV pump is located in Room 302. This type of tracking can even be used to export data into middleware that associates equipment to patients either for billing purposes or infection-control analytics.
CSE: How have your engineers worked with building owners and facility managers to implement integrated technology in these structures?
Hood: We have found that integrating health care technology into the built environment has been most successful when a facility forms a strategic-technology steering committee. This team should combine clinical, operational, and technical members. Leading this team in establishing technology-integration requirements and adapting to technology advancements during the life of the project helps facilities break down traditional communication silos to keep the project on track.
CSE: When incorporating IoT-ready products or technologies, what are some of the most pressing challenges or concerns when working on health care buildings and medical facilities? Discuss patient privacy or other concerns.
Hood: Compliance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) and network security are major concerns for health systems today. Hospital cyberattacks and ransomware are growing, and the IoT expands a health system’s risk exposure. Developing IT network-security requirements for any project’s systems or devices on a network should be part of your overall project-team discussions. Developing a thorough project process with the hospital’s IT network team to review and approve project-related items can help facilities protect their patients’ data.
CSE: What types of system integration and/or interoperability issues have you overcome for these projects, and how did you do so?
Jones: For a long time, many building owners sought, and many controls manufacturers claimed to provide, a true open-protocol BAS. By open protocol, I mean nonproprietary in the sense that BAS manufacturer “A” could install the system and BAS manufacturer “B” could immediately maintain and service it without being encumbered by proprietary elements. I’m not sure such a system actually exists. The root problem is that the service over the life of a BAS system that the building owner receives varies over time and region. Building owners often want to purchase a BAS from one manufacturer that doesn’t lock them into a 50-year relationship with a company whose ongoing service might decline. A portion of the solution has arrived in the way of gateways that combine multiple BAS into a consolidated front end. However, I still believe that proprietary gremlins are scattered throughout the offerings from most BAS manufacturers. Overcoming these issues requires clear specifications, detailed submittal reviews, and open discussions with controls providers.
Hood: Integrating medical devices, IT systems, and building systems across diverse platforms can be challenging. Facilitating an interoperability-assessment workshop with the hospital’s technical team and the owner’s vendors helps overcome typical project issues by quickly narrowing the focus to a set of key integration areas that must be addressed. Developing a clear integration plan, action items, and schedule that overlaps with the project schedule is needed. This process helps the design team understand and specify key systems-integration requirements that often become scope gaps on many projects.
CSE: Is your team using BIM in conjunction with the architects, trades, and owners to design a project? Describe an instance in which you’ve turned over the BIM to the owner for long-term operations and maintenance (O&M) or measurement and verification (M&V).
Isherwood: We are using REVIT to create BIM models up to Level 300. We have been very cautious using that model for long-term O&M. From our experience on other non-health care-related projects, we found that it was very tedious to update the BIM model with the manufacturer’s information after shop-drawing approval, and then it did not interface with the owner’s operations program.
Harwell: I have not seen any owner using BIM as the living document it can and should be, unfortunately. Facility managers are still struggling to keep full-time equivalent employees, and having personnel with the expertise to use BIM in this capacity seems to be the roadblock. I believe they would sooner hire more electricians and HVAC technicians than a BIM manager. For this to be a successful tool for facility technicians and not just designers, the technicians need to understand how useful it is. BIM does not appear to have reached this point.
Hood: BIM provides great value to the entire design and construction team, and we use it on almost all projects. Some owners have even begun using BIM after project completion. One unique BIM implementation integrated the owner’s facilities management software to the BIM model. Manufacturer and model numbers of all technology systems were included. Biomedical and IT asset-tag information was entered into tags and the IT devices and medical equipment were integrated into each family in the model. The owner used this information to merge into their facilities management software for tracking and maintenance of equipment.
Jones: Essentially every project we have been involved with over the past several years has used BIM for 3-D planning and field-fit coordination. The only exception being very small-scale renovation projects where reasonable fees can’t absorb the creation of an accurate existing model. Progress is being made in providing valuable O&M data within the design model that is turned over to the owner. Major equipment can be easily tagged with design conditions, submittal data, and maintenance requirements. One interesting technology related to this subject that we have been using is 3-D walkthrough photography of our finished spaces and mechanical rooms. We have hired a company to create these photographic walkthroughs, onto which we’ve added annotation to major valves, gauges, and new technologies, as well as linked submittal data for major equipment.
CSE: What specialized technologies or capabilities have you specified for medical facilities? Describe the technology systems and their challenges/solutions.
Hood: We have implemented various tracking and patient-flow systems to help improve staff efficiencies, improve care, and enhance the patient experience. These solutions range from real-time locating systems and process-driven light-signaling systems to automated event-driven notification systems integrated with the electronic medical record system. Each of these technologies can have multiple layers of system-integration points on diverse platforms, which must be thoroughly coordinated. Clearly specifying the requirements for each step in the clinical workflow process is necessary for proper system programming. We have found that engaging the clinicians in detailed discussions with biomed and IT staff during system design is key to a successful implementation.
Jones: One major challenge in health care revolves around maintaining appropriate conditions within operating rooms. Surgeons want the rooms very cold, sometimes at 60 degrees or even lower, and we are code-required to keep the humidity below 60% RH. This often requires us to deliver colder, drier air to the room than what is easily achieved with 42°F chilled water from a typical central plant. Desiccant wheels or glycol subcooling are two typical strategies to address this. On several recent projects, we have had great success with wraparound heat pipes. This technology involves two additional heat-transfer coils: The first is located before the cooling coil to precool the air and connected to the second coil, which is located after the cooling coil to reheat the air. The result is that we’re able to get additional dehumidification out of the cooling coil, allowing us to deliver drier air to the operating room.